HOW TO USE THIS BOOK

NANDA International (NANDA-I) describes its purpose as

follows:
NANDA International exists to develop, refi ne and promote ter-
minology that accurately reflects nurses’ clinical judgments. This
unique, evidence-based perspective includes social, psychological
and spiritual dimensions of care (NANDA-I, 2009).
Standardization of nursing actions and common terminol-
ogy is important in the provision of consistent care over time,
among nurses, across shifts, and even between different health-
care agencies. This text incorporates the nomenclature of
Taxonomy II that has been adopted by NANDA-I.
There are those individuals who believe that NANDA’s list
is incomplete. My intent is not to judge the completeness of this
list but rather to suggest the need for clinical testing of what is
available. NANDA encourages nurses to submit new diagnoses
for consideration, after testing and research of that diagnosis has
been conducted in the clinical setting.
There are three essential components in a nursing diagnosis,
which comprise the PES format. The “P” identifies the prob-
lem (or human issue of concern), the “E” represents the etiol-
ogy (or cause) of the problem, and the “S” describes a cluster of
signs and symptoms, or what has come to be known as “defi ning
characteristics.” These three parts are combined into one state-
ment by the use of “connecting words.” The diagnosis would
then be written in this manner: Problem (or issue of concern)
“related to” etiology “evidenced by” signs and symptoms (defi n-
ing characteristics).
The problem can be identified as the human response to
actual or potential health problems as assessed by the nurse. The
etiology may be represented by past experiences of the individ-
ual, genetic influences, current environmental factors, or patho-
physiological changes. The defi ning characteristics describe
what the client says and what the nurse observes that indicate
the existence of a particular problem.
Nursing diagnoses, then, become the basis for the care plan.
This book may be used as a guide in the construction of care
plans for various psychiatric clients. The concepts are presented
xxvii
xxviii ● INTRODUCTION
in such a manner that they may be applied to various types of
health care settings: inpatient hospitalization, outpatient clinic,
home health, partial hospitalization, and private practice, to
name a few. Major divisions in the book are identified by psychi-
atric diagnostic categories, according to the order in which they
appear in the Diagnostic and Statistical Manual of Mental Disor-
ders, Fourth Edition, Text Revision (DSM-IV-TR, APA, 2000).
The use of this format is not to imply that nursing diagnoses are
based on, or flow from, medical diagnoses; it is meant only to
enhance the usability of the book. In addition, I am not suggest-
ing that those nursing diagnoses presented with each psychiatric
category are all-inclusive.